• ADHD books published by NorthEast Books & Publishing, by Association for Youth, Children and Natural Psychology
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Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness, by Elliot S. Valenstein

This is a lively, fascinating, and yet scholarly account of the history of the use of psychosurgery in treating mental disorders. Focused in particular on the extraordinary Walter Freeman, with whom psychosurgery is most as sociated, the book explores the rise in use of lobotomies and similar procedures through the 1950s and the decline ever since (apart from a brief flurry in the 1970s).

Valenstein, a research psychologist and the author of Brain Control (1973), writes in a lucid, even-handed way even while concluding with a strong plea for restraint in the use of untested medical interventions. The book makes compelling reading for both laypeople and scholars. However, its narrow focus on psychosurgery makes it interesting mainly as history. Paul Hymowitz, Psychiatry Dept., Cornell Univ. Medi cal Ctr., New York. Copyright 1986 Reed Business Information, Inc.


Last Resort: Psychosurgery and the Limits of Medicine (Cambridge Studies in the History of Medicine), by Jack D. Pressman

During the 1940s and 1950s, tens of thousands of Americans underwent some form of psychosurgery; that is, their brains were operated upon for the putative purpose of treating mental illness.

From today's perspective, such medical practices appear foolhardy at best, perhaps even barbaric; most commentators thus have seen in the story of lobotomy an important warning about the kinds of hazards that society will face whenever incompetent or malicious physicians are allowed to overstep the boundaries of valid medical science. Last Resort challenges the previously accepted psychosurgery story and raises new questions about what we should consider its important lessons.


Psychosurgery: Damaging the Brain to Save the Mind, by Joann Ellison Rodgers

A history of psychosurgery from icepick lobotomies to present techniques examines the pros and cons of such surgery and reviews the types of procedures used, assessing the moral and medical issues involved.


Psychosurgery: Webster's Timeline History, 1942 - 2007

Webster's bibliographic and event-based timelines are comprehensive in scope, covering virtually all topics, geographic locations and people. They do so from a linguistic point of view, and in the case of this book, the focus is on "Psychosurgery," including when used in literature (e.g. all authors that might have Psychosurgery in their name).

As such, this book represents the largest compilation of timeline events associated with Psychosurgery when it is used in proper noun form. Webster's timelines cover bibliographic citations, patented inventions, as well as non-conventional and alternative meanings which capture ambiguities in usage.


Psychosurgery in Veterans Administration hospitals: Joint hearing before the Subcommittee on Health of the Committee on Labor and Public Welfare and...Ninety-third Congress, first session, by U.S. Congress, Senate, Committee on Labor and Public Welfare. Subcommittee on Health.

Psychosurgery: Report and recommendations


My Lobotomy, by Howard Dully, Charles Fleming

At twelve, Howard Dully was guilty of the same crimes as other boys his age: he was moody and messy, rambunctious with his brothers, contrary just to prove a point, and perpetually at odds with his parents. Yet somehow, this normal boy became one of the youngest people on whom Dr. Walter Freeman performed his barbaric transorbital—or ice pick—lobotomy.


Photo credit: John A Beal, PhD. Dep't. of Cellular Biology & Anatomy, Louisiana State University Health Sciences Center Shreveport. Lobotomy, www.wikipedia.org

Photo: John Kloepper, at Central States Hospital, Milledgeville GA, 22DEC06


Page updated: December 31, 2012

Psychosurgery - Use, Types and Side Effects


Prefrontal lobotomy, cingulotomy, capsulotomy
Brief history and modern use


Normal human brain, frontal
Frontal view of normal human brain.

Psychosurgery can also be referred to as neurosurgery. Psychosurgery's first use in modern times was reported by Burkhardt in 1891. (Cosgrove, Rauch, 2005).The most well known example of dramatic psychosurgery is that of the prefrontal lobotomy.


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First used in Portugal, the prefrontal lobotomy, particularly for violent patients in mental hospitals, was rendered upon tens of thousands of patients between 1935 and 1955. As is often the case with newly developed therapeutic techniques, initial reports of results tended to be enthusiastic, downplaying complications, (including a one in four death rate) and undesirable side effects.


Side Effects of Psychosurgery, Lobotomy, and Modern Law


Permanent inability to inhibit impulses, an unnatural "tranquility" with undesirable shallowness of absence of felling, were some of the disturbing side effects of the prefrontal lobotomy.

In 1951, the Soviet Union banned all such operations. The operation is rare today, however, law still permits it in the U.S. and many other countries, so that there has been something of a comeback in a modified form of the treatment for some difficult to treat disorders.

Ice Picks-surgical instruments used for the lobotomy
Ice picks such as these were often used in performing lobotomies.


Why and When Psychosurgery Was and Is Utilized


Psychosurgery in general is still relatively rare, and used as a last resort for the intractable psychotic, severely and chronic cases of OCD (Obsessive Compulsive Disorder), and occasionally in treating severe pain in the case of terminal illness.

Cosgover and Rauch (Harvard) state, "Surgical intervention remains an important therapeutic option for disabling psychiatric disease and is probably underutilized." Despite this, they also state concerning psychosurgery, "However, despite these modern treatment methods, many patients fail to respond adequately and remain severely disabled," after psychosurgery. (Cosgrove, Rauch, 2005).

See the book, Great and Desperate Cures by Elliot Valnestein, where he explains how the treatment came to be accepted. Valnesteing concluded that psychiatrists needed to gain accepting as a medical science, and that the use of surgery fitted well into that need in the 1930s and 1940s. Also, it proved to be a cost-effective treatment, and a way to maintain control over mental patients.


Modern Use of Psychosurgery and Types of Disorders for Which it is Utilized


Various forms of psychosurgery are performed today in neurosurgical centers in general hospitals in the United States and elsewhere.

Some of the conditions for which various types of nuerosurgery is performed are,

  • Parkinson's Disease
  • Epilepsy
  • Obsessive Compulsive Disorder (OCD)
  • Obsessive Neurosis
  • Additionally, psychosurgery has been performed, not as commonly, for,

  • Schizophrenia
  • Anxiety Neurosis

  • Modern Psychosurgery Techniques


    Today, the rate of permanent damage to the brain has been substantially improved with psychosurgery in comparison to the historical use of psychosurgery procedures, and there are fewer severely detrimental side effects. However, serious side effects can still be experienced by a significant percentage of those who undertake psychosurgery today and extreme caution is in order with any psychosurgery procedures.

    Cingulotomy

    A small bundle of nerve fibers that connect the frontal lobes with the limbic system is interrupted, with a precise operation.

    Consgrove and Rauch (Harvard) report concerning cingulotomy, that "although the patient may experience an immediate reduction in anxiety, there is generally a delay to the onset of beneficial effect on depression and obsessive compulsive disorder. This latency may be as long as six to twelve weeks and must be clearly explained to the patient and referring psychiatrist.

    If there has been no response to the initial cingulotomy after three to six months, then reoperation and enlargement of the cingulotomy lesion is considered." There have been over 800 cingulotomies performed at the Massachusetts General Hospital (MGH) since 1962. (2005)

    Cingulotomy is the treatment of choice in this country whereas in Europe, capsulotomy and limbic leucotomy are more prevalent. They all appear roughly equivalent therapeutically but in terms of unwanted side effects, cingulotomy appears to be the safest of all procedures currently performed. (Cosgrove, Rauch, 2005).


    Statistical effectiveness of Cingulotomy


    The results of bilateral cingulotomy in 198 patients suffering from a variety of psychiatric disorders were reported retrospectively by Ballantine et al in 1987. With a mean follow-up of 8.6 years, 62% of patients with severe affective disorder were found to have had worthwhile improvement.

    Similarly, in patients with obsessive compulsive disorder approximately 56% were found to have undergone worthwhile improvement. In 14 patients suffering from nonobsessive anxiety disorders 50% were found to be functionally well and 29% were found to have shown marked improvement. A recent retrospective study evaluating cingulotomy in 33 patients with refractory obsessive compulsive disorder demonstrated that using very strict criteria for successful outcome, at least 25 to 30% of patients benefited substantially from the procedure. [Jenike and Baer, 1991].(Cosgrove, Rauch, 2005).


    Capsulotomy - Psychosurgery Involving Drilling Small Holes in Skull


    Originally developed in Sweden, capsultomy is a surgery which involves drilling very small holes in the skull, and inserting tiny electrodes in the brain. The electrodes are heated up, which destroys the adjacent cellular structures.

    When there is little response from the first surgery, a repeat, deeper surgery is performed. The rate of resurgery is reportedly 20%.(Cosgrove, Rauch, 2005). Neurosurgery without the need to drill has been developed using a gamma knife or proton beam.


    Anterior Capsulotomy - Facts and Statistics


    In the first 116 patients operated on by Leksell, 50% of patients with obsessional neurosis and 48% of depressed patients had a "satisfactory" response. Only 20% of patients with anxiety neurosis and 14% of patients with schizophrenia showed any improvement. In this classification system, only patients who were free of symptoms or markedly improved were judged as having a satisfactory response.

    Of the patients who were rated as worse after capsulotomy, nine were schizophrenics, four were depressives and three obsessives. Percentages of Success and Failure with Capsulotomy Psychosurgery

    Satisfactory Response to Capsultomy

  • Obsessional Neurosis - 48%
  • Anxiety Neurosis - 20%
  • Schizophrenia - 14%
  • Rated Worse After Capsultomy Psychosurgery - 14%


    Deep Brain Stimulation - Highly Experimental Neurosurgery for Chronic Depression


    Deep brain stimulation is a highly experimental neurosurgical treatment for chronic depression in which the brain is stimulated with electrical impulses.

    Although it's been approved for several other conditions, deep brain stimulation hasn't been approved by the Food and Drug Administration (FDA) for depression treatment and is in the early stages of research.

    Requiring brain surgery, deep brain stimulation is the most invasive form of brain stimulation treatment for depression. Deep brain stimulation works much like a pacemaker for your brain.


    Deep Brain Stimulation Risks


    Any surgical procedure carries risks including all types of brain surgery. Deep brain stimulation involves brain surgery and is an especially risky procedure posing both risks within the brain from the surgery, as well as general health risks. The brain stimulation itself may cause severe side effects.

    Possible surgical complications may include:

  • Bleeding in the brain
  • Stroke
  • Infection
  • Breathing problems
  • Nausea
  • Heart problems
  • Incision scarring
  • Possible side effects of deep brain surgery after surgery

  • Bleeding in the brain
  • Seizure
  • Infection
  • Delirium
  • Unwanted mood changes, such as mania and depression
  • Movement disorders
  • Lightheadedness
  • Insomnia
  • Dizziness
  • Device malfunction
  • Temporary tingling in your face or limbs
  • Also, people who have undergone deep brain stimulation to treat Parkinson's disease have reported a variety of problems, including:

  • Panic attacks
  • Mania
  • Speech difficulty
  • Movement problems
  • Increased suicidal thoughts and behavior
  • The long-term risks and side effects of deep brain stimulation for depression aren't known.
    (Deep Brain Stimulation. MayoClinic.com. http://www.mayoclinic.com/health/deep-brain-stimulation/MY00184)


    Conclusion of Effectives of Psychosurgery on OCD Patients


    There have not been enough studies on psychosurgery to make firm conclusions. In one small study of 35 patients with OCD who underwent capsulotomy and were followed prospectively by independent psychiatrists, 16 were rated as free of symptoms and nine were much improved for an overall satisfactory result of 70%.(Cosgrove, Rauch, 2005). Side effects, however, are not considered in this report

    In another study of about 253 severe OCD patients, about one-half experienced a 35% reduction in intensity of symptoms after surgery. ( Mindus, eta all, 1993, 1994).

    Psychosurgery for OCD

  • 50% experienced a 35% reduction in intensity of symptoms
  • No deaths occurred and increased risk of suicide was not reported in this study.


    Psychosurgery References:


    1. Carson, Robert. C., Butcher, James, N., Mineka, Susan, (2000). Abnormal Psychology and Modern Life. 11th Edition. Boston: Allyn & Bacon

    2. Cosgrove, G. R., MD., FRCS(C), Rauch, S.L., MD, (May 31, 2005). PSYCHOSURGERY. Departments of Neurosurgery and Psychiatry, Massachusetts General Hospital and, Harvard Medical School, Boston, Massachusetts

    3. Deep Brain Stimulation. (July 31, 2008). Mayo Clinic. http://www.mayoclinic.com/health/deep-brain-stimulation/MY00184

    4. MGH Psychiatric Neurosurgery Committee, (May 11, 2005). Massachusetts General Hospital.

    5. Neurosurgery Service, Functional and Stereotactic Surgery Center. Massachusetts General Hospital.


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